Abstract

OBJECTIVES:

To assess the associations of fresh fruit consumption and total physical activity with all-cause and cardiovascular mortality among Chinese adults who have been diagnosed with cardiovascular disease (CVD) or hypertension.

METHODS:

During 2004-08, the China Kadoorie Biobank study recruited 70,047 adults, aged 30-79 years, with physician-diagnosed stroke or transient ischaemic attack, ischemic heart disease, or hypertension. Information on diet and physical activity was collected using an interviewer-administered electronic questionnaire. Cox regression was used to yield hazard ratios (HRs) for the independent and joint associations of fresh fruit consumption and total physical activity with mortality.

RESULTS:

At baseline, 32.9% of participants consumed fresh fruit regularly (i.e. >3 days/week) and the mean total physical activity were 15.8 (SD = 11.8) MET-hr/day. During ~7-years follow-up, 6569 deaths occurred with 3563 from CVD. Compared to participants with <1 day/week fruit consumption, regular consumers had HR (95% CI) of 0.84 (0.79-0.89) for all-cause mortality and 0.79 (0.73-0.86) for CVD mortality. The HRs for the top vs bottom tertile of physical activity were 0.68 (0.64-0.72) and 0.65 (0.60-0.71), respectively, with no clear evidence of reverse causality. After correcting for regression dilution, each 100 g/day usual consumption of fresh fruit or 10 MET-hr/day usual levels of physical activity was associated with 23-29% lower mortality. The combination of regular fruit consumption with top 3rd of physical activity (>16.53 MET-hr/day) was associated with about 40% lower mortality.

CONCLUSION:

Among Chinese adults with pre-existing vascular disease, higher physical activity and fruit consumption were both independently and jointly associated with lower mortality.

a) and b) are the associations of fresh fruit consumption with all-cause and CVD mortality, and c) and d) are the associations of physical activity with all-cause and CVD mortality. Analyses were stratified by age-at-risk, sex, region, and baseline CVD status, and adjusted for education, income, smoking, consumption of alcohol, dairy products, meat and preserved vegetables, survey season, diabetes status, family history of CVD, CVD medication, poor health status, and fruit consumption or physical activity, where appropriate. The boxes represent hazard ratios, with the size inversely proportional to the variance of the logarithm of the hazard ratio, and the vertical lines represent 95% confidence intervals. The numbers above the vertical lines are point estimates for hazard ratios, and the numbers below the lines are numbers of events. The x-axis location of each box corresponds to the group average of usual fruit consumption or usual physical activity for each category of participants.

Analyses were stratified by age-at-risk, sex and region, and adjusted for education, income, smoking, consumption of alcohol, dairy products, meat and preserved vegetables, survey season, diabetes status, family history of CVD, CVD medication, poor health status, and physical activity. Convention as in . Black boxes were for participants with baseline prevalent CVD and the grey boxes were for those without prevalent CVD at baseline.

Adjusted HRs for all-cause and CVD mortality by total physical activity, stratified by baseline CVD status.

Analyses were stratified by age-at-risk, sex and region, and adjusted for education, income, smoking, consumption of alcohol, dairy products, meat and preserved vegetables, survey season, diabetes status, family history of CVD, CVD medication, poor health status, and fruit consumption. Convention as in . Black boxes were for participants with baseline prevalent CVD and the grey boxes were for those without prevalent CVD at baseline.